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module 103 - theme 4 > respiratory pharmacology > Flashcards

respiratory pharmacology Flashcards

1
Q

what are the different bronchodilators?

A
  • adrenergic agonists: beta 2 agonists
  • muscarinic antagonists/anticholingergics
  • ipratropium-short acting anti muscarinic
  • methylxanthines
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2
Q

give 3 examples of adrenergic agonists

A
  • salbutamol
  • salmeterol
  • formotetol
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3
Q

what is tiotropium?

A

long acting anti muscarinic

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4
Q

give an example of a methylxanthine

A

aminophylline

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5
Q

what are the 2 types of anti inflammatory drugs used for the airway?

A
  • steroids

- leukotriene receptor antagonists

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6
Q

give an example of one oral and one inhaled steroid

A 
oral = prednisolone
inhaled = beclomethasone
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7
Q

how do pressurised metered dose inhalers (pMDIs) work?

A
  • deep inhale
  • inhale and puff
  • hold breath for slow 10 count
  • exhale slowly
  • wait one minute before second puff
  • use spacer/aerochamber
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8
Q

how do dry power inhalers work?

A

one inhalation not a puff

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9
Q

what is the duration of salbutamol?

A

short acting (begin immediately, 3-5 hour duration)

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10
Q

what are the routes for salbutamol?

A

inhaled or nebuliser (higher dose), intravenous (very rarely used)

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11
Q

what is the mechanism of action of salbutamol?

A

binding to beta 2 receptors in the lungs results in relaxation of bronchial smooth muscle. it is believed that salbutamol increases cAMP production by activating adenylate cyclase and the actions of salbutamol or mediated by cAMP. it is a short acting beta agonist

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12
Q

when is salbutamol used?

A

asthma and COPD

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13
Q

what is the duration of salmeterol?

A

long acting (begin 2-30 mins, 10-12 hour duration)

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14
Q

what are the routes for salmeterol?

A

inhaled

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15
Q

what is the mechanism of action for salmeterol?

A

long acting beta-adrenoreceptor agonists

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16
Q

when is salmeterol used?

A
  • asthma in patients requiring long term regular bronchodilator therapy on ICS not PRN and always used with ICS in asthma
  • COPD for persistent symptoms despite SABA (either LABA/LAMA combinations of ICS/LABA combination)
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17
Q

what is the duration of formoterol?

A

long acting (with short onset similar to salbutamol but with prolonged duration 10-12 hours)

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18
Q

what are the routes for formoterol?

A

inhaled

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19
Q

what is the mechanism of action for formoterol?

A

long acting beta-adrenoreceptor agonist

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20
Q

when is formoterol used?

A

asthma and COPD, combined with ICS (always) for asthma

21
Q

what is the duration of tiotropium?

A

long acting (24 hours), once daily

22
Q

what is the route of tiotropium?

A

inhaled (dry power hand inhaled/mist respimat)

23
Q

what is the mechanism of action of tiotropium?

A

long acting muscarinic antagonist (LAMA). it had similar affinity to the subtypes of muscarinic receptors M1 to M5. in the airways, it exhibits pharmacological effects through inhibition of M3 receptors at the smooth muscle leading to bronchodilator

24
Q

what are the indications to use tiotropium?

A
  • stable COPD: symptoms despite SABA (any severity and with LABA)
  • asthma: in not improving ICS/LABA specialist advice from hospital
25
Q

what are the key features of ipratropium?

A
  • short acting antimuscarinic agent
  • onset 30 minutes, lasts for 6 hours
  • nebulised
  • nebulised for acute presentations of COPD and sometimes asthma
26
Q

what is the duration of theophylline?

A

half life around 5 hours in a healthy adult

27
Q

what are the routes of theophylline?

A

oral/intravenous

28
Q

what is the mechanism of action for theophylline?

A

phosphodiesterase inhibitor that requires monitoring of level (blood level)

29
Q

what are the indications to use theophylline?

A
  • oral: COPD and asthma with persistent symptoms

- intravenous: COPD and asthma in medical emergencies

30
Q

what are the adverse effects of bronchodilators?

A
  • tachycardia
  • nervousness, irritability, tremor
  • inhaled preparations: less common
  • oral preparation (hardly used) and intravenous: more side effects are common - tachycardias/angina
  • usually dose related
31
Q

what are the characteristics of systemic glucocorticoids?

A
  • IV or oral
  • stronger effects as higher doses
  • action unaffected by inspiratory effort/inhaler technique
  • more side effects, especially with long term therapy
32
Q

give an example of a systemic glucocorticoid

A

prednisolone

33
Q

what are the characteristics of inhaled glucocorticoids?

A
  • localised action
  • fewer side effect: some absorption occurs
  • disease may prevent penetration of drug to affected areas
34
Q

give 3 examples of inhaled glucocorticoids

A
  • beclometasone
  • fluticasone
  • budesonide
35
Q

what are the airways effects of glucocorticoids?

A
  • decrease release of inflammatory mediator
  • decrease infiltration and action of white blood cells
  • decrease airways oedema
  • decreased airways mucus production
  • increase number and sensitivity of beta-2 receptors
36
Q

what are the adverse effects of inhaled glucocorticoids?

A
  • oral candidiasis: white plaques in mouth

- dysphonis

37
Q

what are the general adverse effects of glucocorticoids?

A
  • adrenal suppression
  • bone loss: exercise, vit D, calcium
  • slow growth in children, but ultimate height
  • increased risk of cataracts and glaucoma
  • increased risk of infection
  • gastric ulceration
  • hypertension
  • diabetes
  • mood distrubance
38
Q

what are the 3 combination of drugs used in ICS/LABA combination inhalers?

A
  • formoterol/budesonide
  • formoterol/beclomethasone
  • salmeterol/fluticasone
39
Q

what is an example of a combination of drugs used in LAMA/LABA combination inhalers?

A

tiotropium/olodaterol

40
Q

what are the 3 drugs used in an ICS/LABA/LAMA combination inhaler?

A

beclomethasone/formoterol/glycopyrronium

41
Q

what are the different drugs used for allergic rhinitis?

A
  • antihistamines: H1 antagonists, side effects = drowsiness, dry mouth, dry eyes, confusion
  • intranasal glucocorticoids
  • montelukast: inhibit leukotriene receptors, decrease inflammation, bronchoconstriction, oedema, mucus, recruitment of eosinophils
  • sympathomimetics
42
Q

what are the different types of respiratory infections?

A
  • bronchitis: COPD and asthma
  • community acquired pneumonia (CAP): severity scoring
  • hospital acquired pneumonia HAP (early and late)
  • ventilator acquired pneumonia (VAP)
  • aspiration
  • bronchitis doesn’t equal pneumonia: have different treatment
43
Q

what are the 2 types of antibiotics used to cover respiratory infections?

A
  • amoxicillin

- co-amoxiclav

44
Q

what are the key features of amoxicillin?

A
  • moderate spectrum, bacteriolytic, B lactam antibitoic
  • routes: IV/oral
  • use: CAP (typical), COPD exacerbations, bronchitis
  • active against gram negative and gram positive bacteria
45
Q

what are the key features of co-amoxiclav?

A

amoxicillin is susceptible to degradation by B lactamase producing bacteria so can be combined with clavulinic acid - a beta lactamase inhibitor

46
Q

what are the key features of tetracyclines?

A
  • inhibits protein synthesis
  • broad spectrum action gram positive and gram negative
  • useful for atypical infections
  • oral route only
  • side effects: GI upset, staining, teeth, lupus, alergy, photosensitivity
47
Q

give an example of a tetracylcine

A

doxycycline

48
Q

what are the key features of quinolones?

A
  • mechanism of aciton: DNA fragmentation
  • gram postiive and positive coverage (and Pseudomonas)
  • route: IV/oral/inhaled
  • side effects: GI upset, C difficule, tendinitis, liver upset, prolonged GTC and arrhythmia
49
Q

what are the key characteristics of macrolides?

A
  • commonly used in respiratory infection (including atypical pneumonia)
  • mechanism of action: protein synthesis inhibitors
  • route: IV/PO
  • gram positive/limited gram negative cover
  • side effects: GI, allergy, liver abnormality, prolonged GTC and interactions

module 103 - theme 4 (19 decks)

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